Acute care toolkit: acute medical care for frail older people

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This toolkit from the Royal College of Physicians recommends procedures for both initial assessment for older people on admission to acute care and later comprehensive geriatric assessment (CGA).

Staff working in acute medical units (AMUs) will be familiar with the increasing number of frail older people requiring access to acute care. The AMU provides a key role in identifying the urgent and important issues which, if addressed accurately and comprehensively, will improve patient outcomes. Accordingly, acute medical teams need to possess the knowledge and skills, and demonstrate the appropriate behaviours, for managing frail older people.

One of the challenges is that of non-specific presentations, such as delirium, that can mask serious underlying pathology. Delivering a holistic assessment in the AMU is difficult for acute teams, with large numbers of patients to see quickly. Geriatric liaison teams, which have the skills and time to focus on frail older people, can be helpful.

Better integration between primary care, emergency departments, AMUs and geriatric services, all working towards achieving high standards of urgent care, should reduce duplication and improve outcomes.

To tackle these issues, the Royal College of Physicians have developed this toolkit which looks at the challenges and makes recommendations to improve outcomes.